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“Improving Access to External VA Care through Enhanced Scheduling Technology”

House Veterans Affairs Committee, Technology Modernization Subcommittee Hearing

May 5, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Dr. Lisa Arfons: Acting Deputy Assistant Under Secretary for Integrated Veteran Care, Veterans Health Administration, U.S. Department of Veterans Affairs

• Mr. Chris Faraji: President, WellHive

• Mr. Jed Hansen: Executive Director, Nebraska Rural Health Association

Keywords mentioned:

• External Provider Scheduling (EPS) system, community care, access, appointment scheduling, provider network, technology modernization, referral management, rural health, healthcare delivery, administrative burdens, quality of care, training, implementation challenges, provider participation

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairman Tom Barrett discussed the importance of improving scheduling for veterans referred to community care. He described the current process as inefficient and burdensome, often requiring repeated phone calls that delay timely care. He praised the External Provider Scheduling (EPS) system for reducing appointment scheduling time to seven minutes and increasing staff productivity, but he criticized the Biden administration for pausing its expansion and removing active sites. He called for the Trump administration to restore and expand the program, citing both national urgency and his own personal negative experience with the outdated scheduling process.

• Ranking Member Nikki Budzinski acknowledged the importance of community care, particularly in rural areas, while expressing concern that it might undercut the VA’s ability to deliver direct care. She criticized the Trump administration’s proposed $500 million cut to the VA’s IT budget, noting that current community care scheduling is archaic, fax-based, and averages 20 days. While praising EPS's promise of faster scheduling, she underscored the need to improve surrounding workflows, eligibility reviews, and documentation processes. The Ranking Member advocated for veterans to have complete and transparent access to wait time comparisons between VA and community care so they can make informed healthcare decisions.

SUMMARY OF KEY POINTS

• Dr. Lisa Arfons stated that EPS is already improving veteran access to care by streamlining the scheduling process through a single interface. She reported that EPS had expanded from 16 to 36 sites under Secretary Doug Collins’ leadership, with 18 more planned by the end of the fiscal year. She outlined the system’s benefits in enhancing the veteran experience, reducing administrative burdens, and strengthening provider partnerships. Dr. Arfons asserted that EPS is no longer experimental and committed the VA to national expansion and continual improvement based on real-world feedback.

• Mr. Chris Faraji described WellHive’s EPS platform as a real-time, user-friendly scheduling tool that is transforming how the VA connects veterans to community care. He highlighted that EPS had increased appointment scheduling by 121% in the first four months of 2025 and had significantly boosted staff productivity. Despite early challenges, he credited strong leadership and bipartisan support for recent momentum and spoke about EPS’s scalability. Mr. Faraji also noted that EPS paves the way for veteran self-scheduling and better data transparency to empower veterans with healthcare choices.

• Mr. Jed Hansen shared how EPS has been successfully implemented in Nebraska and detailed how the state’s rural health associations accelerated adoption through outreach, training, and partnerships. He relayed the story of a Navy SEAL veteran who faced long waits and fragmented care, illustrating why EPS is vital for rural veterans. He made five recommendations to scale EPS nationally, including rural provider support, electronic health record (EHR) integration, and stronger federal-local collaboration.

• Chairman Barrett asked Mr. Faraji to confirm whether WellHive integrates with community care partners in a way that allows VA schedulers to view appointment availability. Mr. Faraji explained that WellHive meets providers where they are by integrating directly with their EHR systems. When asked if the technical integration varies by system, Mr. Faraji explained that every EHR is different, but the technical side is generally straightforward once providers understand the benefits. He added that WellHive handles the integration at no cost to the provider and has already built connections with many systems.

• The Chairman then turned to Mr. Hansen and asked whether VA reimbursement rates are sufficient to encourage rural hospitals to participate. Mr. Hansen replied that while nothing in rural health care is particularly lucrative, many rural providers are motivated by a desire to improve access for veterans in their communities rather than financial incentives. Chairman Barrett agreed, noting the importance of local access for veterans who might otherwise face long drives to reach VA facilities.

• Chairman Barrett then asked how many community care referrals had been made in fiscal year 2024. Dr. Arfons responded that over 14 million referrals had been made to date and that the volume has increased over recent years. She attributed the growth to a combination of factors including expanded programs like the PACT Act, increased awareness, and improved availability of community care.

• Ranking Member Budzinski expressed concern over the Trump administration’s actions in recent months, particularly staffing cuts and the effect they may have on technology modernization efforts. She asked whether members of referral coordination teams were affected by the February probationary terminations. Dr. Arfons replied that she could not confirm this, as those teams are managed at the facility level. Additionally, Dr. Afrons could not confirm whether any staff were affected by workforce reduction plans, whether these positions had been exempt from the hiring freeze, or if staff had opted into the deferred resignation program.

• The Ranking Member then asked what assessments the VA conducts before rolling out EPS to ensure that staffing is adequate. Dr. Arfons explained that the VA evaluates site readiness by reviewing referral patterns, workflow capacity, leadership support, and the availability of providers in the region. She noted that this process is ongoing and metrics are reviewed continuously, but concerns like deferred resignations are not currently factored in.

• Turning to the effectiveness of EPS, Ranking Member Budzinski asked how much time EPS has saved in the scheduling process. Dr. Arfons said that traditional scheduling took about 33 days, whereas EPS reduced it to 25 days on average. The Ranking Member then asked whether veterans are informed about provider backgrounds, such as training on military sexual trauma (MST) or PTSD. Mr. Faraji stated that EPS currently only gives provider availability and location, and it does not include such detailed qualifications.

• Rep. Morgan Luttrell questioned Mr. Faraji about resistance to EPS adoption, citing a provider in Texas who reported that they were still evaluating it. Mr. Faraji explained that the complexity of integration varies by institution, and while some require multiple stakeholders, the process is manageable.

• Rep. Luttrell then asked Dr. Arfons about the pace of EPS expansion, wanting clarification on whether the VA plans to expand to all 170+ sites. Dr. Arfons responded that they are currently expanding to 54 sites by the end of the fiscal year and will use lessons from those rollouts to guide future implementation.

• Rep. Luttrell asked whether EPS had failed in Nebraska. Mr. Hansen said that there had been no failures and that the program had been well received, especially after he personally advocated for it. When asked whether similar partnerships could be replicated in other states, Mr. Hansen said yes, citing several organizations across the country that could play a similar liaison role. Mr. Faraji added that WellHive has replicated Nebraska’s success in places like Arkansas and is seeing a 21% increase in provider onboarding month over month.

• Chairman Barrett asked whether the VA had studied how EPS impacted the distance veterans travel for care. Dr. Arfons replied that they had not but would take that question for the record. The Chairman then asked whether VA partnerships with community care are generally strong in Nebraska. Mr. Hansen confirmed that they are, especially in rural areas where community care helps fill gaps for primary care, emergency services, and follow-up care.

• The Chairman also inquired whether the EPS rollout is coordinated with the VA’s EHR modernization efforts. Dr. Arfons replied that while there is no formal alignment yet, they are exploring opportunities to better integrate these systems.

• Chairman Barrett then asked whether WellHive can support small practices that do not use major EHR systems. Mr. Faraji confirmed that they can and that WellHive works with each provider individually to develop integration plans, even if the provider uses basic tools like Microsoft Outlook. When asked if providers often use multiple scheduling systems, Mr. Faraji said that it varies, but they aim to unify scheduling and prevent duplicate bookings.

• Ranking Member Budzinski asked whether WellHive had the capacity to share data on cultural competency and wait times with VA staff. Mr. Faraji responded that the platform was flexible and could display any information the VA directed it to.

• The Ranking Member discussed quality-of-care metrics from community care providers. Dr. Arfons responded that the VA monitors training compliance and is developing a more robust quality program. It has not yet collected national-level data on document returns.

• Ranking Member Budzinski inquired whether upcoming Third Party Administrator (TPA) contracts could require the collection of such quality data. Dr. Arfons stated that she could not speak to acquisition details but acknowledged that the VA is evaluating what information best supports quality care. Ranking Member Budzinski asked if the VA had controls to ensure ineligible providers were excluded. Dr. Arfons confirmed that EPS checks the exclusion list daily. Mr. Faraji added that WellHive does track utilization metrics on its platform.

• The Ranking Member then asked whether the VA planned to establish timeliness standards for community care appointments, referencing open Government Accountability Office (GAO) recommendations. Dr. Arfons explained that while direct care has scheduling standards, network adequacy in community care is assessed by TPAs using differing metrics. Ranking Member Budzinski expressed concern that, without consistent standards, veterans lack transparency in scheduling. She urged the VA to improve data collection and implement clear guidelines to help veterans make informed care decisions.

• Rep. Luttrell asked whether EPS reduced the nine-step scheduling process for community care. Dr. Arfons confirmed that EPS significantly cut down the steps, particularly by eliminating back-and-forth communication. Rep. Luttrell then asked how the VA defines success and pushed for a more veteran-focused measure. Dr. Arfons replied that success means delivering care when and where veterans need it, and EPS is helping the VA move toward that goal.

• Rep. Luttrell emphasized the urgency of implementation, stating that his veteran constituents demand faster progress. Dr. Arfons reported marked improvements since September, including onboarding 4,000 additional providers and scheduling over 3,000 EPS appointments in the most recent month.

• Chairman Barrett asked why EPS had not yet been rolled out to every VA facility. Dr. Arfons explained that the VA’s fiscal year 2025 deployment strategy focused on fewer, regional rollouts to engage larger providers who could serve multiple VA facilities. Chairman Barrett expressed concern that this approach might neglect small or rural providers critical to veteran access. Dr. Arfons clarified that the VA is still working with small providers but has found more efficient rollout when larger networks are involved early.

• The Chairman questioned whether rollout could begin with limited providers and expand over time, rather than waiting to reach network thresholds first. Dr. Arfons acknowledged that this is the VA’s current approach but claimed that aligning VA staff readiness and provider availability was essential to avoid mismatches that could hinder adoption.

• Chairman Barrett asked about EPS training and was told it requires only a 30-minute initial course and an hour-long interactive session, with further optional supports. He also asked if EPS appears “invisible” to providers, and Mr. Faraji confirmed that once integrated, community providers simply see appointments populate in their EHRs. Chairman Barrett pressed again on why full rollout is not already underway, pointing out that the system is relatively easy to use and does not require provider-side training.

• Ranking Member Budzinski thanked Mr. Hansen for his insights on rural challenges and asked how Congress and the VA could streamline EPS implementation. Mr. Hansen recommended working with EHR vendors like Oracle Cerner and Epic to reduce costly interface fees for small providers and suggested federal appropriations to support critical access hospitals. He also underlined the importance of outreach and awareness, particularly in remote regions like Nebraska’s panhandle.

• The Ranking Member praised Mr. Hansen’s comments on aligning quality measures and asked Dr. Arfons about uneven EPS performance across sites like Orlando and Columbia. Dr. Arfons explained that variability is expected in new initiatives and that site leadership and veteran population needs affect adoption speed. Ranking Member Budzinski asked how the VA plans to standardize the recruitment of community care providers. Dr. Arfons said that engaging medical center directors has proven key because of their existing relationships and leadership influence.

• Rep. Luttrell asked how many VA facilities WellHive is targeting. Mr. Faraji clarified that EPS is being implemented at VA medical centers — not smaller clinics — totaling 172 nationwide.

• Rep. Luttrell asked if WellHive could implement the software at all sites now. Mr. Faraji replied that the technology is ready, but successful rollout depends on collaboration with each site’s leadership, staff training, and network readiness. When asked how long it takes to onboard a site like the Houston VA, Mr. Faraji stated that it depends on data sharing and coordination with community care providers. Mr. Hansen added that academic medical centers take longer due to their complexity, while smaller hospitals may onboard more quickly. He explained that one Nebraska hospital adopted EPS aggressively, while another started with a narrow scope of specialties to ease the transition.

• Rep. Luttrell expressed frustration that onboarding can take months, despite the ease of training, and warned that lengthy delays undermine confidence in the rollout. Mr. Hansen explained that early hesitation was driven by mixed signals and uncertainty over whether EPS would be sustained, but recent testimony and leadership engagement should reassure providers.

• Chairman Barrett asked whether EPS could exchange referral and authorization documents. Mr. Faraji replied that WellHive is awaiting FedRAMP High security authorization, which it expects to receive by fall 2025. Once secured, the platform will be able to transmit referrals with scheduled appointments. Chairman Barrett confirmed that this is an industry-standard security step and asked why the process takes so long. Dr. Arfons took the question for the record.

• The Chairman asked whether the VA would begin integration planning before the final security approval. Dr. Arfons replied that technical integration would follow security clearance. Chairman Barrett encouraged the VA to pursue both in parallel to save time.

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